Most medics lack expertise to spot delirium ‘superbug’

Failure to identify delirium in patients can accelerate death or potentially lead to dementia if left untreated — yet the majority of medics lack the expertise to diagnose the “cognitive superbug”.

David Meagher, who is professor of psychiatry at the University of Limerick, said the health service needed to devise a response “as profound as that around MRSA” to tackle the level of delirium in Irish hospitals, which affects one in five adult patients.

“We have a condition that really impacts on people’s quality of life, not just in general hospitals, but across healthcare environments.

“The problem is so prevalent that it warrants the type of campaign that has been used to address MRSA. We have started to refer to it as the ‘cognitive superbug’, but importantly, it is highly preventable and treatable.”

Prof Meagher took part in a joint UL-UCC study of delirium at Cork University Hospital that was recently published in the British Medical Journal, where a team of medics went into the hospital on a single day to assess more than 300 adult patients.

Almost one fifth had delirium. Yet studies show less than 50% of cases of delirium are identified.

“Many cases are missed because delirium has a number of different presentations. In its obvious form, the patient may be very agitated and trying to get into the wrong bed or whatever. But in other cases the picture is much less compelling and may not be obvious at all. The patient can be very withdrawn and quiet and delirium can be misdiagnosed as depression.”

The professor, who is principal investigator in HRB-funded research which aims to improve diagnosis and management of delirium, dementia and depression among palliative care patients, said delirium was essentially “a toxic state in the brain,” which, when undiagnosed, increased the risk of mortality in elderly medical patients by 11% for every two days of delirium experienced.

“It also frequently deprives families of meaningful contact in the final stages of an illness,” he said.

Moreover, recent studies suggest that when left untreated, delirium, which is largely reversible, may lead to dementia.

“Studies show that people who are admitted to hospital with no cognitive problems, particularly the elderly who come in for something like a major heart operation, in many cases become confused post-op and frequently go on to develop long-term cognitive problems.”

Prof Meagher is part of a research programme that is trying to improve detection of delirium, including through the use of technology such as apps.

“A lot of the time when people are very physically sick, their brain starts to fail, and routine testing of brain function with simple app-based tests can readily identify patients who are developing delirium.”

He said the health service needed to devise a systemic approach to identifying and managing delirium which could improve patient care and substantially reduce healthcare costs.